Success in Optional Vena Cava Filter Retrieval. An Analysis of 246 Patients

Predictors of retrieval and long-term mortality in patients treated with inferior vena cava filters

OBJECTIVE

Inferior vena cava filters (VCFs) are a therapeutic resource for the treatment of patients with thromboembolic disease who have a contraindication to full-dose anticoagulation. In the present study, we report the retrieval rate and long-term mortality of patients receiving optional inferior VCFs and identify the predictors for retrieval and all-cause mortality during follow-up.

METHODS

We conducted a retrospective cohort study of 739 consecutive recipients of optional inferior VCFs from January 2002 to December 2021 in two hospitals. Different clinical characteristics and procedure-related variables were included in the analysis. The all-cause mortality rate and retrieval rate and the predictive factors were evaluated using multivariate analysis.

RESULTS

Of the 739 patients, 393 (53%) were women. The mean patient age was 69 ± 15 years. Of the patients, 67% presented with pulmonary thromboembolism and 43% with deep vein thrombosis (DVT). A contraindication to anticoagulation was present for nearly 90% of the patients, mainly (47%) related to the surgical procedure. In addition, 44% of the patients had active cancer. Follow-up data were available for 94% of the patients, with an average follow-up time of 6.08 ± 5.83 years. Long-term mortality was 53%. Cancer (odds ratio [OR], 3.60; 95% confidence interval [CI], 2.22-5.83), age (OR, 1.03; 95% CI, 1.08-1.42), and DVT (OR, 2.01; 95% CI, 1.08-1.42) were identified as independent predictors of mortality. The retrieval rate at follow-up was 33%. The predictors for retrieval included the indication of the filter related to a surgical procedure (OR, 4.85; 95% CI, 2.54-9.59), the absence of cancer (OR, 2.89; 95% CI, 1.45-5.75), and younger age (OR, 0.98; 95% CI, 0.97-0.99).

CONCLUSIONS

High long-term mortality was observed. The predictors of mortality were cancer, older age, and DVT. One third of the filters implanted were retrieved. The predictors for retrieval were a contraindication to surgery-related anticoagulation, the absence of cancer, and younger age.

Difficult withdrawal of an inferior vena cava filter: Technical considerations and associated variables

OBJECTIVE

To analyse the efficacy of the procedure for withdrawing an inferior vena cava (IVC) filter and the clinical and radiological factors associated with difficult withdrawal.

MATERIAL AND METHODS

This retrospective observational study included patients who underwent IVC filter withdrawal at a single centre between May 2015 and May 2021. We recorded demographic, clinical, procedural, and radiological variables: type of IVC filter, angle with the IVC > 15°, hook against the wall, and legs embedded in the IVC wall > 3 mm. The efficacy variables were fluoroscopy time, success of IVC filter withdrawal, and number of attempts to withdraw the filter. The safety variables were complications, surgical removal, and mortality. The main variable was difficult withdrawal, defined as more than 5 min fluoroscopy or more than 1 attempt at withdrawal.

RESULTS

A total of 109 patients were included; withdrawal was considered difficult in 54 (49.5%). Three radiological variables were more common in the difficult withdrawal group: hook against the wall (33.3% vs. 9.1%; p = 0.027), embedded legs (20.4% vs. 3.6%; p = 0.008), and >45 days since IVC filter placement (51.9% vs. 25.5%; p = 0.006). These variables remained significant in the subgroup of patients with OptEase IVC filters; however, in the group of patients with Celect IVC filters, only the inclination of the IVC filter >15 ° was significantly associated with difficult withdrawal (25% vs 0%; p = 0.029).

CONCLUSION

Difficult withdrawal was associated with time from IVC placement, embedded legs, and contact between the hook and the wall. The analysis of the subgroups of patients with different types of IVC filters found that these variables remained significant in those with OptEase filters; however, in those with cone-shaped devices (Celect), the inclination of the IVC filter >15° was significantly associated with difficult withdrawal.

Non-retrieved inferior vena cava filters: causes and long-term follow-up

BACKGROUND

Temporary inferior vena cava (IVC) filters are not always retrieved. Information about long-term outcomes of patients with indwelling filters is scarce. Aims of our study were to assess reasons that preclude retrieval of temporary IVC filters and long-term outcomes and causes of death in patients with indwelling filters.

MATERIALS AND METHODS

Retrospective observational study including all consecutive patients undergoing IVC filter insertion from January 2009 through December 2018. Patients with permanent filters and those with temporary filters not retrieved were followed from insertion until June 2020.

RESULTS

We included 271 patients with a mean age of 63.8 years. The main indication for filter insertion was acute venous thromboembolism and contraindication for anticoagulation (83%). The filter was deemed as permanent in 24.4% of patients and temporary in 75.6%. Sixty six percent of temporary filters were retrieved; the main cause of non-retrieval was lack of planning / follow-up (57.9%). One hundred twelve patients (41.3%) remained with indwelling filters. After follow-up, 54.5% were alive and 45.5% had died, with a median survival time of 6.19 (95% CI, 2.63-9.75) years. The most frequent cause of death during follow-up was cancer (49%). The frequency of anticoagulant therapy was similar in both groups (57.4%% versus 54.9%).

CONCLUSIONS

The main preventable cause of non-retrieval of temporary IVC filters was lack of planning / follow-up. Structured follow-up programs should be implemented to increase retrieval rates. In patients with indwelling filters, the main cause of death was cancer and extended anticoagulation was not associated with survival.